New Public-Private Partnership To Focus on Improving Quality, Safety and Affordability of Health Care

On April 12, 2011, The U.S. Department of Health and Human Services (HHS) announced its intentions to form a public-private partnership with stakeholders such as patient advocates, healthcare providers and leaders at major hospitals. Called Partnership for Patients, this national initiative was created to improve quality and safety in health care, while also substantially reducing health care costs. HHS estimated that the partnership could save up to $35 billion in health care costs. Under the authority of the Affordable Care Act, HHS will invest $1 billion dollars towards this endeavor.

The two main goals will be to assist hospital patients by (1) preventing injury and further illness and (2) eliminating or mitigating complications that would adversely affect patient recovery. To learn more about the Partnership for Patients, please visit HealthCare.gov.

FTC and DOJ Propose Enforcement Policy for Healthcare Antitrust Laws

The Federal Trade Commission and the U.S. Department of Justice have jointly issued a proposed enforcement policy for the application of the antitrust laws to healthcare collaborations among otherwise independent providers and provider groups that seek to participate as accountable care organizations (ACOs) under the Medicare Shared Savings Program. The agencies seek public comments until May 31, 2011, on the proposed enforcement policy and the new antitrust “safety zone” it would create.

For more information and the proposed antitrust policy, please visit the FTC and DOJ’s Proposed Statement.

CMS Releases Long-Awaited Proposed Rule on Accountable Care Organizations

On March 31, 2011, the Centers for Medicare & Medicaid Services (CMS) and Health and Human Services (HHS) unveiled the long-awaited federal rule on accountable care organizations. This proposed rule would implement section 3022 of the Affordable Care Act, which allows service providers and suppliers to continue receiving traditional Medicare fee-for-service payments under Parts A and B, and to be eligible for additional payments based on meeting specified quality and savings requirements.

To view the proposed rule, please visit the Office of the Federal Register website.

A Summary of Medicare Shared Savings Program and ACO Proposed Regulations

On March 30, 2011, the Centers for Medicare and Medicaid issued the long-awaited, proposed regulations for the Medicare Shared Savings Program, including details of the requirements for qualifying as an accountable care organization (ACO), such as:

  • Eligible legal entities
  • Criteria for shared governance
  • Assignment of beneficiaries to ACOs
  • Different types of risk contracts
  • Benchmarks and calculations of savings
  • Shared savings, antitrust issues and policies, Medicare anti-kickback, and other regulatory requirements as applied to ACOs

The full text of the summary is available as a Duane Morris Alert.

Civil Money Penalties for Nursing Homes

On March 18, 2011, the U.S. Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS) issued this regulation, implementing section 6111 of the Affordable Care Act. Section 6111 gives CMS authority to impose and collect civil monetary penalties (CMPs) against nursing homes. The penalties are reserved for nursing homes that fail to comply with federal participation requirements outlined in section 6111. Although penalties for noncompliance existed before the Affordable Care Act was promulgated, this regulation revises and expands CMS’s authority to impose and collect CMPs. The final rule is effective January 1, 2012.

For additional information about this new regulation, please visit the Office of the Federal Register website.

Changes to Hospital Outpatient Prospective Payment System (OPPS), the Ambulatory Surgical Center Payment System, and Hospital Reimbursements for Graduate Medical Education (GME)

This regulation was adopted to correct technical and typographic errors identified in a final rule published November 24, 2010, titled “Medicare Program: Hospital Outpatient Prospective Payment System and CY 2011 Payment Rates; Ambulatory Surgical Center Payment System and CY 2011 Payment Rates; Payments to Hospitals for Graduate Medical Education Costs; Physician Self-Referral Rules and Related Changes to Provider Agreement Regulations; Payment for Certified Registered Nurse Anesthetist Services Furnished in Rural Hospitals and Critical Access Hospitals.” The errors were found in the preamble and addenda B, AA and BB of the November 2010 final rule. The new regulation also incorporates changes to the Medicare Physician Fee Schedule (MPFS) for CY 2011, which appeared in a January 11, 2011, CY 2011 MPFS correction notice. The corrections are effective January 1, 2011, as if they were initially included in the November final rule.

More information about the November final rule can be found here. A detailed summary of the corrected errors can be found on the Office of the Federal Register website.

12 Proposed Recommendations for Accreditation of Patient-Centered Medical Homes

On March 8, 2011, a coalition comprised of physicians representing the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association, announced its completion of 12 new recommendations for accreditation organizations to use when developing and implementing standards for the patient-centered medical homes (PCMHs). The PCMHs are a central component of the Patient Protection and Affordable Care Act (ACA). The coalition developed the guidelines in anticipation of accreditation organizations, such as the Joint Commission, building upon its recommendations to establish updated standards for the PCMHs.

For additional information, please refer to the coalition’s guidelines.

New Grant Funding Opportunity to Help States Monitor and Challenge Rising Health Insurance Premiums

On February 24, 2011, the U.S. Department of Health and Human Services (HHS) announced that states can begin to apply for a second round of grants, which they can use to create or improve existing health insurance premium review programs. Approximately $200 million is available to states to better track and review premium rate increases, and make the rate process more transparent to consumers. HHS anticipates that the state review programs will also enable states to challenge or even prevent unreasonable premium increases from being implemented. This round of grants marks the federal government’s continued effort to combat rising health insurance premiums.

To read more about this announcement and to see how to access grant funding, please go to http://www.healthcare.gov/news/factsheets/ratereview02242011a.html.

$45 Million More in Federal Funding to Assist Medicaid Beneficiaries

On February 22, 2011, the U.S. Department of Health and Human Services (HHS) announced that it would provide $45 million in grant funding to 13 states for the startup and operation of Money Follows the Person (MFP) demonstration projects. States operate MFP programs to provide financial support and assist Medicaid beneficiaries with moving from institutions (i.e., hospitals and nursing facilities) and transitioning back into their communities to live in their own homes or other facilities. HHS anticipates that this federal funding will help 13,000 more Medicaid beneficiaries, and it will continue to provide grant funding through 2016 by committing at least $621 million to the state projects.

To read more about this announcement and see the list of 13 states scheduled to receive grant funding, please go to http://www.hhs.gov/news/press/2011pres/02/20110222b.html.

Medicare and Medicaid Programs; Requirements for Long-Term Care Facilities; Notice of Facility Closure

Issued by the U.S. Department of Health and Human Services (HHS)on February 18, 2011, this regulation implements section 6113 of the Patient Protection and Affordable Care Act (PPACA). The interim final rule amends existing legislation by introducing new notice requirements associated with long-term care (LTC) facility and skilled nursing facility (SNF) closures. Its purpose is twofold: to protect resident health and safety, and to facilitate a “smooth transition” in the event of a facility’s closure.

Continue reading “Medicare and Medicaid Programs; Requirements for Long-Term Care Facilities; Notice of Facility Closure”

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The opinions expressed on this blog are those of the author and are not to be construed as legal advice.

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